Health sector reform and women's rights.

During the 1990s, a number of countries in Latin America and the Caribbean launched reforms of the health sector. These reforms were part of broader initiatives throughout the region to reorganize the State apparatus in the context of redefining the governments' social agendas. This process has been called the "modernization of the State."

This phenomenon is also an integral part of the neoliberal macroeconomic policies that currently hold sway and an aspect of the ongoing process of globalization in every sphere: industry, commerce, information, communication, technology, etc. Nonetheless, these changes have affected different sectors of the population quite unequally.

Countries such as Colombia and Argentina spearheaded these initiatives in our region while others such as the Dominican Republic, Guatemala and El Salvador began the long process of health sector reform fairly recently. By 1995 nearly every country and territory in Latin America and the Caribbean was immersed in this process or was on the brink of implementing reform, but the characteristics of the reforms varied depending on the social, political and economic context of each country.

Some experts maintain that the health sector reforms aim to increase equity in health care services, to improve the efficiency of health sector management and to make the health system more responsive to the growing needs of the population. Above all, the governments claim that the guiding principle of the reform process is universal access. However, on-the-ground realities show that these objectives are not being fulfilled by the reforms currently being implemented in the region.

The reforms of the State--among them health sector reform--follow the development model imposed by the powerful international financial institutions led by the World Bank. This model encourages economic growth to the detriment of human development, privileging an economic perspective over ethical concerns for people's rights and well-being and the preservation of the environment. As a result, the loans these institutions make to governments are tied to "packages" of adjustments that must be implemented unilaterally to spur economic growth, but at a tremendous social cost.

The spirit of the reforms in these "instant solutions" proposed by the multilateral lending agencies seems to be dominated by the needs of the market rather than human solidarity. Under these models of development, the State is gradually abandoning its historic responsibilities to public health and paving the way for the privatization of services that are profit-driven and that exclude the poorest sectors of the population. Thus, in most of our countries, health is being transformed from a human and civil right into a product which can only be accessed by those with sufficient economic resources.

The negative impact that health sector reform has in practice is evident in the fact that access to health care has actually decreased, and quality, quanity and coverage of these services has plummeted. In addition, a number of discriminatory factors have been accentuated by the reforms; the situation of women is emblematic. Not only are women the primary users of the health services, they are also the caregivers of their families and communities. Perversely, however, the private systems in most countries "punish" women for their reproductive potential by charging women of reproductive age much more for their health plans than those offered to men of the same age group.

Multi-Sectoral Commitments

This regional reality has stimulated many women's groups and networks, national and international organizations, scholars and experts to become involved in health sector reform, ensuring the effective participation of civil society in its design and implementation. The Latin American and Caribbean Women's Health Network shares this concern and commitment and is developing the project, "Health Sector Reform in the Region: Urgent Responses for Women's Sexual and Reproductive Health." Sponsored by the Ford Foundation, this project has the following objectives:

General Objective:

* Empower the Latin American and Caribbean women's health movement by means of interregional dialogue on the issue of the impact of health sector reforms on sexual and reproductive rights in order to develop an agenda for advocacy on sexual and reproductive rights in the context of reform.

Specific Objectives:

* Make known the impact of health sector reforms on women's sexual and reproductive rights and encourage public debate on this issue.

* In those countries of the region in which the Network has a stronger presence, provide women's groups and organizations of civil society in general with technical information which can be used in advocacy and lobbying activities related to health sector reforms and their implications for women's sexual and reproductive rights.

* Develop and implement a communications strategy to promote greater awareness of this issue.

* Disseminate an advocacy model that is simple and easy-to-understand and that can be used in any country of the region, as a product of the women's movement to be shared with key actors and potential or current allies.

* Strengthen the links forged by LACWHN's Itinerant University between the academic world (especially in the area of women's and gender studies) with the women's movement around the issue of Health Sector Reform, as the starting point for future collaborations.

Exchanging Perspectives

In this context, the Women's Health Network hosted a roundtable on the development of health sector reforms and their impact on women's health, June 13-14, 2003, in Santiago, Chile. Representatives from six countries in our region attended and presented reports on the state of the reforms in Latin America and the Caribbean. The review draft of LACWHN's Advocacy Manual on Health Sector Reform was also distributed to the participants. The meeting culminated with a brainstorming session on immediate actions that could be taken by the Latin American and Caribbean women's health movement in light of the current conditions of the health and social security systems in our countries and the process of reform being implemented in the region.

This meeting was also a step towards the regional workshop which will be held in Lima, Peru, October 1-3, 2003. At this workshop, some 40 experts in health sector reform and public policy will work together to create an agenda for advocacy and lobbying for sexual and reproductive rights, based on their analyses of the impacts of health sector reform. The participants will also discuss the formation of strategic alliances with other sectors of society sensitive to women's issues, particularly other networks and NGOs, academics, researchers, legislators, etc., with whom we can develop initiatives to urge our governments to prioritize gender equity in the health sector reforms and to ensure that these processes do not exacerbate health inequalities in terms of access, care and status that women are already suffering.

At the same time, the Network will also develop an information and communications strategy within the women's movement and to reach out to women in civil society in general. Key to this aspect of the Reform Project is LACWHN's new website, which features a special section dedicated to the issue of Health Sector Reform. Currently in the final stages of production, the new website will be on-line at: http://www.reddesalud.org.

ITINERANT UNIVERSITY: Empowerment Training

In an effort to strengthen women's leadership and involvement in formulating public policy on health and to encourage alliances among different sectors of civil society interested in promoting positive changes on health issues, the Latin American and Caribbean Women's Health Network has offered the International Course entitled "Gender Perspectives in Health" as part of the Itinerant University project since 1998.

This educational endeavor focuses on the issue of "Gender, Globalization and Health Sector Reform." Under this broad scope, several key topics provide a profound understanding of gender inequities and inequalities in health. These issues include: sexuality, the body, and sexual and reproductive rights; gender, work and the environment; bioethics and gender; quality of care in women's health; violence against women; and older women's health.

To date, courses have been offered in Peru (1998); in Chile and Brazil (1999); and in Bolivia (2000). In 2001, the Itinerant University was held in Uruguay, Costa Rica and Venezuela, and in 2002, in Cordoba, Argentina and the Dominican Republic. This year, courses will be offered in Colombia and El Salvador.

The experience of the Itinerant University has shown that women from a wide range of disciplines related to women's health and other related areas have greatly benefited from these educational opportunities and leadership-training experiences. This initiative has helped contribute to the construction of a critical mass in these countries and in the region on the issue of health sector reform and related topics with a gender perspective and should play a meaningful role in monitoring these processes.

For more information about LACWHN's Itinerant University, visit our website: http://www.reddesalud.org

The author is an Argentine psychologist and the Southern Cone Regional Coordinator for the Asociacion Latinoamericana de Medicina Social (ALAMES, Latin American Association of Social Medicine). Ms. Tajer participated in the roundtable recently held in Santiago, Chile, by the Latin American and Caribbean Women's Health Network to explore the issue of health sector reform, in which she shared her extensive experience in the analysis of public health and related topics from a human and civil rights perspective. Interview by Revista Mujer Salud editor Adriana Gomez.